Healthcare Provider Details

I. General information

NPI: 1265268767
Provider Name (Legal Business Name): ABIGAIL GRACE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8469 S MASON MONTGOMERY RD STE 1
MASON OH
45040-4001
US

IV. Provider business mailing address

168 S LIBERTY KEUTER RD
LEBANON OH
45036-9333
US

V. Phone/Fax

Practice location:
  • Phone: 513-280-8891
  • Fax:
Mailing address:
  • Phone: 812-269-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037131
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: